Provider First Line Business Practice Location Address:
13000 JUSTICE AVE.
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-5329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-291-5038
Provider Business Practice Location Address Fax Number:
225-291-2534
Provider Enumeration Date:
06/12/2007